Butt Muhammad Imran, Khalid Bakhsh Abdulmohsen Mohammed, Nadri Quaid Johar
Department of Medicine, King Faisal Specialist Hospital, Research Centre, Al Faisal University, Riyadh 12713, Saudi Arabia.
World J Clin Oncol. 2021 Apr 24;12(4):272-281. doi: 10.5306/wjco.v12.i4.272.
The management of metastatic progressive radioiodine-resistant differentiated thyroid cancer remains challenging for clinicians. The availability of tyrosine kinase inhibitors (TKIs), sorafenib and lenvatinib, within the last decade has expanded treatment options; however, these lead to significant adverse effects, which may curtail their use.
We report the case of a 47-year-old female with Hurthle cell thyroid cancer who underwent total thyroidectomy followed by radioiodine ablation. During follow-up, she developed noniodine-avid renal and pulmonary metastases. With respect to her pre-existing diabetes, hypertension, and polycystic kidney disease, the tumor board decided against performing renal metastasectomy because of the risk of future renal decline requiring dialysis. Metastases were treated using sorafenib, which provided stability followed by progression within a year. We switched to lenvatinib, which led to disease regression. However, the patient experienced severe adverse effects, including cardiomyopathy, bicytopenia, renal impairment, and the rarely reported nephrotic syndrome. Renal metastasis is a rare manifes-tation of Hurthle cell thyroid cancer with only two reported cases in literature. We report the experience of our first case of renal metastasis and its treatment with TKIs. This case serves as a reminder of the adverse drug reactions associated with TKI use.
We advocate close monitoring of patients' hematological and renal profiles as well as their cardiac status using an echocardiogram.
转移性进展性放射性碘难治性分化型甲状腺癌的管理对临床医生来说仍然具有挑战性。在过去十年中，酪氨酸激酶抑制剂（TKIs）索拉非尼和仑伐替尼的出现扩大了治疗选择；然而，这些药物会导致严重的不良反应，这可能会限制它们的使用。
我们报告了一例47岁患有Hurthle细胞甲状腺癌的女性病例，该患者接受了甲状腺全切术，随后进行了放射性碘消融。在随访期间，她出现了不摄取碘的肾和肺转移。考虑到她既往存在的糖尿病、高血压和多囊肾病，肿瘤委员会决定不进行肾转移灶切除术，因为担心未来肾功能下降需要透析。使用索拉非尼治疗转移灶，病情在一年内保持稳定，随后进展。我们改用仑伐替尼，这导致了疾病消退。然而，患者出现了严重的不良反应，包括心肌病、双血细胞减少、肾功能损害以及罕见报道的肾病综合征。肾转移是Hurthle细胞甲状腺癌的一种罕见表现，文献中仅报道了两例。我们报告了首例肾转移病例及其使用TKIs治疗的经验。该病例提醒人们注意与使用TKIs相关的药物不良反应。
我们主张密切监测患者的血液学和肾脏指标以及使用超声心动图监测其心脏状况。
